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Home My WebLink About2171 AMERICAN AVE - Building Permits�� (714) 754-5273 • Fax (714) 754-4856 • www.Ci.COS�a-mBSa.Ce.US 77 FAIR DRIVE, WS I A MtSA, GA y2tizti BUILDING PERMIT Job/+ddress: 2171 AMERICANAV Suite: Vicinity: DUPLEX Parcel Number: 42208113 Applicant: POLANCO, ANNE Address: 18246 CARLSBAD CT FOUNTAIN VALLEY. CA Owner: SELGA, MAXIE BRYAN Address 2414'I BARQUERO DR MISSION VIEJO, CA Contractor: O W N ER-B U I LD ER Address: Zip: Arch : Address: Phone: Zoning: Phone: 714-963-9945 Zip: 92691-4102 Phone: Zip: 92691-4102 Phone: License: 000000 Eng: Address: ISSUED BY: Status: ISSUED Applied: 01/27/2004 Issued: 01/30/2004 Phone: Zip: License: License: SCOPE OF PERMIT REROOF DUPLEX AND ATTACHED GARAGE: T/O EXISTING ROOF, REPAIR/REPLACE SHTG AS NEEDED, FELT PER MFGR'S SPECS, APPLY "30-YEAR TIMERLINE GAF COMP SHINGLES." APPROX 2500 SF Plan Check: $0.00 Permit: $12525 SMIP Res: $0.56 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $125.81 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existinq: o Rear 0- 0 Rear 0- 0 Re uired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Pro osed: 0 Calc Valuation: Claim Valuation Riyht 0- 0 Right 0- 0 ss,soo.00 $s,soo.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requlrements under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically ezpire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor tha work authorized under this permit to be considered legal, such work must comply vnth all applicable codes, and ell required Inspections and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permi�. FOR INSPECTIONS CALL: (714) 7545626 2448d8 (B/00) WORKERS'COMPENSAnON DECLARAnON: I hereby eHirm under penalry of perjury one oi the tollowinq daclarations: ❑ I have antl will maimain a certificete of consent to self-Insure for workers' compensation, as pmvided for by seciion 3700 of the Lebor Code, for the pertormance of the work for which thiS permit is issued. ❑ I have antl will maintain workers' compensation insurance, as required by section 3700 ot the Labor Code, for �he pertormance oF Ihe work for which this pertnit is Issuetl. My workers' comp�nsation Insurance carrier antl policy number are: Cartier: Policy Number. (This section neetl not be completetl i/ the permit is velued at one hundred dollars ($100) or less.) �I cenity Ihat in the pertortnance of the work for which Ihis pertnit is issueq I shall not employ any Derson in any manner so es to become subject to the workers' compensation laws ot California, end egree ihat if I should become subjact to iha workers' compensation provisions oi 5ection 3700 of tha Labor Code, I shall fort�with comply with these pJ�islons�� Applicent Signature: �� /77Aii Date: � jD d WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNIAWFUL AND SHALL SU9IECT AN EMPLOVER TO CflIMINAL PENALTIES AND CIVIL FWES UP TOONE HUNDFED THOUSAND DOUARE (5100,000�, IN ADDITION TO THE COST OF CAMPENSATIIXJ, DAMAGES AS PROVIOED FOR IN SECTION 3106 OF TME IABOR COOE, IMEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirtn ihat I am licensetl untler provisions of Chaptar 9(commencing with Section 7000) of Division 3 of ihe Business and Protessions Code, end my license Is in tull force end eReci. Lic. # Class H Contractors Signature: Date: CONS7RUC710N LENDING AGENCY: ❑ I herehy aHirm Ihat ihere is a consiruction lending agency tor the peAormance of ihe work for which this permi� is issued. (Sec. 3097, Civil Cotle). Lendars Neme: LentleYs Atltlress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eNirm ihat untler penalty of perjury that I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for Ihe toliowing reason (Sec. 7031.5, Business and ProFessions Cotle: Any ciry or counry which requires a permit to constma, elter, improve, tlemolish, or repair any stmcture, prior to its issuance, also requires ihe epplicent for such permit to fle a signetl stetement ihat he or she is Ilcensed pursuent to the pmvisions of the Contradors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business entl Professions Code) or ihat he or she is exempt iheretrom end ihe besis for ihe alleged e:emption. Any violetion of Section 7031.5 by any epplicent for e pertnit su6j the epplicant to a civil penalry of not more ihan five hundred dollars ($500)J: I, as owner ot Ihe propeny, or my employees with wages es their sole compensation, WILL DO THE WORK, and ihe structure is not intended or oHeretl for sale (Sec. 7044, Business antl Professions Coda: The Coniractors License Law does not apply to an owner of property who builds or improves ihereon, end who does such work himself or herselt or ihrough his or her own employees, providetl that such improvements are not intendad or oHered for sale. If, however, the building or improvement is sold within one year of compietion, ihe ownervbuiltler will have the burden ot proving that he or she did not 6uild or improve tor purpose of sale.). ' ❑ I, as owner of the property, am EXCLUSIVELY CONTRAC77NG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professions Code: The contractors License Law tloes not epply to an owner of property who builtls or improves thereon, antl who comracts tor such project with a contrecror(s) license pursuant to the Contractors License Laws.). ❑ I em eaem � nder 50 Signature: Owner ID verified by driver's license. ❑ Ves ❑ No eusiness antl Venfication oi Ownership by (type ot tlocumem, i.e. - property tax bill or deed): ons coae ior mis reason: �� Date: � O License No. Expires: /� JO-0 S DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more faat in depth into which a person Is required to descend, will be metle in connection with work authorizetl by ihis pertnit, and Ihat no building sWcwre, scaHolding, lalsework, or demoli�ion or tlismantling thereof, will be more Ihan thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, California Adminisiretive Code). ❑ As ownervbuilder, I will not employ enyone to do work which would require a permit irom �he Division ot Industnel Satery, as noted ebove, unless such person has e permi� �o do such work from ihe division. Signature: Date: Division ol Induslnal Safery Permit Number: CERTIFICATE OF COMPLIANCE AND AUTHORVA710N OF ENTRV: I certify under penalry of perjury ihat I have read ihis application and state ihat the information given is correct I agree to comply with all stete laws and ciry ordinances relating to building construction, entl authonze representatives of Ihe Ciry of Costa Mesa to enter upon the ebove-described properry for inspection purposes. I agree not to occupy or allow acupancy ot any building euthorized by this permit until finel inspection. 7 i Signatur IOwner(s) l�/Yi oi/tic o��ir � And/OrAuthorizedApplicant CODE t. INSVECTIONTYVE 1616 Fixed System Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Roof 201 Final Block/Retaining Wall 202 Final Fectory Fire Place 203 Final Sign 204 Final Demolition �� - 2/-OG9 I L COUEi INSPELTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 212 220 Final Elecincal Final Fire Preventlon Final Planning Approval 222 Final Site 250 Final Building/Occupancy P�IE 1[�L$ ��J� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 977 C09TA MEBA. CALIPORNIA For Applicant +o Fill In Complefely TYpE OR PRINT BUILDING 2171 American Avenue ADDRESS COSTA MESA. CALIFORNIA � aooREss 1533 Baker 5t. Gardan I .. ._ . . _. .� ��. � '' ,..l� � �� FEB 20?�31 � fll!ANCE DEPT. /�i CII �r OF COSTA MESA � APPLICATION FOR PERMIT BUILDING Fo� Offiee Use Only RECEIPT NO. PERMIT NO. FIRE ZONE IIIC• APPROVEO BY COSTA MESA. ADDRE55 1 33 Baker St. � ZONING CITY Costa Mesa C$�• �ONE I NO.OP � uee oa xew R� PLAN9 2 BUIIDINO �£ STATE 16Z293 No: � 9-].151 �eoa� ' llc. No. oe9cR�PTlox SIZE <<.__ __ -. Nr /.. � r'1. I NO. OF BLD09....� BLTBAGK LWE FROM CeNTER OF eTPEET � REAR YARD � SIDE YARD I LEFT 7� I RIGHT 7T � DESCRIPTION OF WORK - Ms1� sroeirs 1 EXTERIOR WALL R COVERING 9�EllCCO C USE OF BUILDING AND WORK attached garage (two living units.) Plan BR 1 HERE6Y ACKNOWLED6E THAT I HAVE READ TH19 APPLIGTION AND BTATE THAT THE ABOVE IS CORRELT ANO AOREE TO GOM- PLY WITX ALL CITV OPDINANCE6 AND BTAT¢ LAW9 qEGU1.ATING BWLDINO WNBTRUCTIpJi.� � / IAUTHORIZED AGENT Dike & Co18�.'ove� Inc. fC8NT8R LINB 8TJ Gar. 1ll�l sq. ft. THE AMOUNT BHOWN IINOER VALIIATION 16 FOR TH¢ PURP082 OF EBTABLI6HING A PERMIT FEE ONLY. VALUATION PERMIT FEE $ 37p�00 s 17,979�W PLAN CHECK $ 1V�SO